Claims Adjustor

Remotedxb; Dubai; On-site; AED 60,000 - 90,000; Full time

Job summary

Centivo is seeking a claims processor to adjudicate claims in assigned queues, applying written Policies and SPD. You will review system edits to ensure benefits are applied correctly and route inconsistencies to Plan Build or Provider Maintenance teams.

You will deny claims when information is missing, generate concise correspondence to participants or providers, and maintain daily, weekly, and monthly production levels while supporting quality improvement initiatives.

Qualifications

• Must have a high school diploma or GED.
• Experience with automated, integrated claims processing systems.
• Knowledge of healthcare claims, medical coding, and Benefit Plan rules.
• Excellent oral and written communication skills.
• Ability to work in a fast-paced environment with production deadlines.
• Proficiency in Microsoft Office and web-based software.
• Strong critical thinking and independent decision-making skills.

Responsibilities

• Adjudicate claims in assigned work queues based on Policies, Procedures, and SPD.
• Review system-generated edits to ensure benefits are applied correctly per client funds.
• Route claims to Plan Build or Provider Maintenance teams for inconsistencies or pricing discrepancies.
• Deny claims for additional information when necessary and generate concise correspondence to participants or providers.
• Maintain daily, weekly, and monthly production levels.
• Participate in department quality improvement and process improvement efforts.
• Process claims under moderate supervision while meeting production and quality goals.

Skills

Critical thinking

Independent decision-making

Communication skills

Microsoft Office

Web-based software

Ability to work under deadlines

Education

High School diploma or GED

Tools

HealthRules Payer

Job description

About the Company

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers.

Responsibilities

• Adjudicate claims in assigned work queues based on written Policies and Procedures and Summary Plan Documents (SPD).
• Review system-generated edits to ensure benefits are applied correctly per client funds.
• Route claims to Plan Build or Provider Maintenance teams when inconsistencies or pricing discrepancies arise.
• Deny claims for additional information when necessary and generate concise correspondence to participants or providers.
• Maintain daily, weekly, and monthly required production levels.
• Participate in departmental quality improvement and process improvement efforts.
• Process claims under moderate supervision while meeting production and quality goals.

Requirements

• Prior experience with a highly automated and integrated claims processing system.
• Knowledge of healthcare claims, medical coding, and Benefit Plan rules.
• Strong critical thinking and independent decision-making skills.
• Excellent oral and written communication skills.
• Ability to work in a fast-paced environment with production deadlines.
• Proficiency in Microsoft Office and web-based software.
• High School diploma or GED required.

Preferred Qualifications

• Experience working with HealthRules Payer.